全麻复合硬膜外阻滞对胃癌根治术中血糖及皮质醇的影响

Effects of general anesthesia combined with epidural block on serum level of sugar and cortisol in patients underwent radical gastrectomy

目的 探讨全麻复合硬膜外阻滞对胃癌根治术中血糖及皮质醇浓度的影响。方法 2 0例择期胃癌手术患者随机分成全麻复合硬膜外阻滞组 (Ⅰ )和单纯全麻组 (Ⅱ ) ,分别于麻醉前 (T1)、诱导插管后 5min(T2 )、手术 6 0min(T3 )、术毕 (T4)及拔管后 30min(T5)抽取静脉血 ,测定血糖及皮质醇的浓度。结果 Ⅰ组患者的血糖自T3 时段升高 (P <0 0 1) ,皮质醇自T4时升高 (P <0 0 5 ) ;Ⅱ组患者的血糖自T2 时就升高 (P <0 0 5 ) ,皮质醇自T3 时升高 (P <0 0 1)。两组间血糖差异无显著性 (P >0 0 5 ) ,但Ⅰ组的升幅较Ⅱ组小 ;皮质醇浓度在T3 、T5时Ⅰ组升幅较Ⅱ组减低 (P <0 0 5 )。结论 全麻复合硬膜外阻滞可减低胃癌根治术中患者血糖和皮质醇浓度的升幅 ,减轻手术引起的内脏牵拉反应及应激反应 。

Objective To evaluate the effects of general anesthesia combined with epidural block on serum level of sugar and cortisol in patients who underwent radical gastrectomy. Methods Twenty patients were randomly divided into two groups: general anesthesia combined with epidural group (groupⅠ, n =10) and general anesthesia group (groupⅡ, n =10). Blood samples for sugar and cortisol measurements were collected into EDTA Vacutainers from vein at the following time:just prior to induction of anesthesia (baseline, T 1), 5 min after tracheal intubation (T 2), 60 min after skin incision (T 3), on completion of surgery (T 4), 30 min after exubation(T 5). Results For patients in group Ⅰ,serum glocose increased in T 3～5 and cortisol increased in T 4～5 ( P <0 05). The patients in group Ⅱ had higher T 2～5 sugar and T 3～5 cortisol compared with the baseline ( P <0 05). Patients in group Ⅰ had significant reduction in T 2, T 5 cortisol compared with group Ⅱ( P <0 05). No significant difference occurred in sugar in group Ⅰcompared with group Ⅱ( P >0 05). Conclusion General anesthesia combined with epidural block can reduce level of sugar and cortisol in patients, is effective to alleviate the stress response evoked by radical gastrectomy and ideal anesthesia for radical gastrectomy.